Shared learning database

Type and Title of Submission


Integrated care documents - a means of implementing NICE guidance




Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG063 - Diabetes in Pregnancy

Category(s) that most closely reflects the nature of the submission:

Implementation policy

Is the submission industry-sponsored in any way?


Description of submission


The care of women with diabetes is complex involving numerous components and a large multiprofessional team. Effective care demands compliance with best practice, good documentation, effective communication, and frequent audit. We had previously produced an effective integrated care pathway (ICP) incorporating the key components of best practice, largely derived from CEMACH. With the issue of NICE CG063 we updated the ICP document to incorporate its recommendations. The primary aim was to inculcate NICE guidance into our clinical practice by prompting clinicians to comply with best practice. Other expected benefits were excellence in documentation, and efficiency of regular audit.


1. Inculcate NICE guidance into clinical practice. 2. Provide practice document which automatically educates new team members. 3. Allow simple means for auditing practice against NICE guidance.


The starting point was the recognition for a system which prompted compliance with local guidelines and good documentation. For the first version we had sought out best practice recommendations from a number of evidence-based sources including CEMACH, Cochrane & NICE. We then wrote out the trail of the patient journey and designed a document around taking care to incorporate patient choice. The document was peer-reviewed and suggestions incorporated into the text. Implementation included sessions on education for the wider maternity team.


Post-implementation the document has been audited showing excellent compliance with key components of best practice. Adjustments have been continually made according to new recommendations, most recently with the release of CG063. We have promoted the document which has taken up by several units and adopted by UK Diabetes and the NHS Clinical Governance site. The success of the document has proved to excellent for team morale.

Results and evaluation

Audits have shown high levels of compliance with key components of best practice. We have recently undertaken a study comparing of outcomes against historical controls. This appears to show an improvement in outcomes. The plan is to publish the findings in the Journal of Integrated Care.

Key learning points

1. The discipline of writing an ICP requires a rigorous approach both in terms of finding best practice but also in terms of formatting the document. 2. Carefully organised ICP production meetings allows all team members to contribute to practice development, allowing the identification of simple practical solutions to effective documentation. The process proved to be good for team morale and the promotion of a multiprofessional approach. 3. Once written, the insert of new practice guidance is simple and allows rapid adoption of key recommendations. 4. A well written ICP structures care well and prompts good practice. The clinic becomes more efficient because team members know precisely where information is kept. 6. Documentation is also promoted by the structure of the document, where defines what information must be recorded. 7. Audit is also made easy by the siting of information within the patient record being constant. 8. New team members frequently volunteered the benefits to them when attending the clinic for the first time. 9. Sections on later pregnancy tasks were less complied with, possibly because of their siting at the end of the document. 10. With the introduction of newer versions, there is a problem of existing patients continuing with earlier (out-dated) versions. 11. It is important to provide free-text for occasions when care diverts from expected pathway. 12. It is essential that the care pathway guides health care workers without limiting the choice for individual patients.

View the supporting material

Contact Details

Name:Robert Fox
Job Title:Consultant Obstetrician
Organisation:Taunton & Somerset NHS Foundation Trust
Address:Musgrove Park
Postcode:TA1 5DA
Phone:01823 342831


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This page was last updated: 22 August 2008

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.